The American Academy of Pediatrics, along with most physicians, recommends an annual well child check for all kids. As our babies become teenagers, that annual well check gets harder to schedule. Our teens have a newfound sense of independence and their schedules are full of school, work and friends. Why should you take the time out of busy schedules, especially when you can drop into an urgent care for a $35 sports physical every other year and satisfy the local school requirements? Why is an annual well child check so important?
The first and foremost reason is that you want your child to learn to be comfortable advocating for their health in the medical environment. As much as we want physicians to be able to sort out health issues and detect health problems before they become serious, physicians often "miss the boat" if our patient isn't used to remembering symptoms or clearly stating their biggest concern. Sit down with your teen for a few minutes before going to the appointment. Write down questions or topics that you want to cover in the visit and then allow your child to ask the questions. I spend many days talking to kids about their health. It is common for me to spend an entire visit with the patient telling me "Everything is fine" only to have their mom call later to explain that their child has missed two weeks of school over abdominal pain or anxiety.
The teen years are one of the most rapid periods of change in our lives. We go through puberty while social relationships become much more complex. Teens often don't tell their parents what is happening—maybe because of their new sense of independence or fear of disappointing their parents. That $35 sports physical covers a physical exam and a screening questionnaire specifically aimed at detecting risk of injury or death from playing sports. It doesn't screen for risky behaviors such as substance abuse or for mood disorders such as anxiety or depression. Your teen is much more likely to be hurt in a car accident involving alcohol or marijuana or to suffer injury or death from suicide than to die on the playing field. You don't want to miss those warning signs. As we all know, if we don't ask, kids don't necessarily tell.
All teen visits should include a discussion of mood and its effect on physical health, as well as specific questions around feelings of suicide. I also include a brief discussion on what to do if a friend discloses feelings of suicide.
What should you expect at a teen visit? Screens! Your doctor should be doing a mood questionnaire and a substance abuse questionnaire starting at the age of 11. It feels crazy to ask 5th graders about alcohol use, but it sets the tone early that a visit to the doctor is about more than the body; it will include behavior and mood questions. You should also expect the physician to gather immunization records. It is really helpful if you have a vaccine record available, especially if you are meeting a doctor for the first time. Parents and other caregivers should come to the visit. We really like to meet the whole family.
At age 11, the doctor will start asking for a short period of time alone with your child. This is to establish trust and ask if there are any sensitive issues your child would like to discuss. Your doctor will check growth, including height and weight. I often use the review of growth to discuss nutrition and exercise, emphasizing the need to avoid large amounts of sugar and eat plenty of vegetables.
Finally, you want your child to be comfortable talking about sexual health. Children have the right to confidentiality regarding sexual health as adolescents. A well child check should include a discussion of puberty, healthy relationships and the opportunity for your child to ask the provider questions. This can be done with a parent in the room, though many teens are more comfortable asking these questions in private. Your doctor may be comfortable prescribing birth control or doing testing for STDs and pregnancy at the request of a teen patient. I encourage teens to discuss these issues with their parents, though they are not required to do so.
Guiding your child through adolescence can be tricky. Helping them prepare for their check-up is a rewarding and informative way to help them launch into the world.